A novel application of amniotic membrane in patients with bullous keratopathy

Hyeon Il Lee, Sang Woo Ha, Jae Chan Kim, Hyeon Il Lee, Sang Woo Ha, Jae Chan Kim

Abstract

To evaluate the efficacy of amniotic membrane in the management of painful bullous keratopathy secondary to the intractable glaucoma and in preventing exposure of drainage devices, we inserted Ahmed valve with amniotic membrane patch graft over the implant itself, and debrided corneal epithelium with amniotic membrane graft over the exposed stroma as a single operation. During the follow-up periods, we monitored vision, intraocular pressure (IOP), presence of ocular pain, and postoperative complications associated with the implants. The mean follow up period was 8.4+/-3.2 months. IOP was well controlled after the intervention. The preoperative mean IOP was measured as 43.9+/-9.0 mmHg and lowered to 16.1+/-1.8 mmHg at the last visit and no complications associated with the implants were noted. Even though the improvement in vision was not prominent, the ocular surface stabilized rapidly and ocular pain associated with bullous keratopathy disappeared soon after surgery. Conclusively the use of amniotic membrane in conjunction with Ahmed valve implantation is an effective way to relieve ocular pain and lessen the chances of complications associated with the implant in patients with intractable glaucoma and bullous keratopathy.

Figures

Fig. 1
Fig. 1
Sequential diagram of operative procedure. (A) Ahmed valve was implanted and drainage tube is inserted into anterior chamber. (B) Exposed tube was covered with amniotic membrane(AM) folded in half. (C) Cornea was covered with disc shaped AM graft with stromal surface abutting cornea (arrow). (D) Finally, large temporary amniotic membrane graft was placed with amnion side down.
Fig. 2
Fig. 2
Biomicroscopic finding of clinical cases. Case 1 (A) Preoperative examination reveals corneal opacity, edema, and bulla formation. (B) Examination 3 months after operation reveals that cornea is clear and stable, and small focal melting of amniotic membrane is noted (arrow head). Case 2 (C) Preoperative finding reveals corneal edema and large bulla formation (arrow). (D) Findings 4 months after operation reveals that cornea is well cleared. Case 3 (E) Total corneal opacity with new vessels and bulla formation. (F) 4 months after operation, we can see well attached amniotic membrane and stabilized ocular surface. (G) The Ahmed drainage tube is seen through the amniotic membrane graft. There is no evidence of complications associated with drainage tube.

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